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Your heart rate can reveal a lot about your health—an elevated resting heart rate (RHR) is a risk factor for heart problems like hypertension, plaque buildup, heart failure, and even early death (it’s actually a sneaky good predictor of longevity1
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It’s no secret that omega-3 fatty acids (ones typically found in fish like salmon and sardines) are critical for the heart, brain, and skin. But they’re also vital during pregnancy (to support healthy brain development of the baby and reduce the likelihood of preterm births) and for women’s reproductive health in general—regardless of whether you’re trying to conceive.
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Does eating fish or taking fish oil supplements reduce stroke risk?
In my last video, we started to explore what might explain the higher stroke risk in vegetarians found in the EPIC-Oxford study. As you can see below and at 0:25 in my video Vegetarians and Stroke Risk Factors: Omega-3s?, vegetarians have a lower risk of heart disease and cardiovascular disease overall, but a higher risk of stroke. We looked into vitamin D levels as a potential mechanism, but that didn’t seem to be the reason. What about long-chain omega-3s, the fish fats like EPA and DHA?
Not surprisingly, their levels are found to be “markedly lower in vegetarians and particularly in vegans than in meat-eaters.” They’re about 30 percent lower in vegetarians and more than half as low in vegans, as you can see below and at 0:45 in my video.
According to “the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date,” combining 28 randomized controlled trials, stroke has no benefit. There is evidence that taking fish oil “does not reduce heart disease, stroke or death,” or overall mortality, either. This may be because, on the one hand, the omega-3s may be helping, but the mercury in fish may be making things worse. “Balancing the benefits with the contaminant risks of fish consumption has represented a challenge for regulatory agencies and public health professionals.”
For example, dietary exposure to polychlorinated biphenyls (PCBs) may be associated with an increased risk of stroke. In one study, for instance, “neither fish nor intake of PCBs was related to stroke risk. However, with adjustment for fish intake,” that is, at the same fish intake, “dietary PCBs were associated with an increased risk of total stroke,” so the PCB pollutants may be masking the fish benefit. If we had a time machine and could go back before the Industrial Revolution and find fish in an unpolluted state, we might find that it is protective against stroke. Still, looking at the EPIC-Oxford study data, if fish were protective, then we might expect that the pescatarians (those who eat fish but no other meat) would have lower numbers of strokes since they would have the fish benefit without the risk from other meat. But, no. That isn’t the reality. So, it doesn’t seem to be the omega-3s either.
Let’s take a closer look at what the vegetarians are eating.
When it comes to plant-based diets for cardiovascular disease prevention, all plant foods are not created equal. There are two types of vegetarians—those who do it for their health, and those who do it for ethical reasons, like global warming or animals—and the latter tend to eat different diets. Health vegans tend to eat more fruits and fewer sweets, for instance, and you don’t tend to see them chomping down on vegan donuts, as shown below and at 2:41 in my video.
“Concerns about health and costs were primary motivations for [meat] reduction” in the United States. A middle-class American family is four times more likely to reduce meat for health reasons compared to environmental or animal welfare concerns, as you can see in the graph below and at 2:55 in my video.
But in the United Kingdom, where the EPIC-Oxford stroke study was done, ethics was the number one reason given for becoming vegetarian or vegan, as you can see in below and at 3:05 in my video.
We know that “plant-based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality”—a lower risk of dying from all causes put together—“in a general US adult population.” But, that’s only for healthy plant foods. Eating a lot of Wonder Bread, soda, and apple pie isn’t going to do you any favors. “For all types of plant-based diets, however, it is crucial that the choice of plant foods is given careful consideration.” We should choose whole fruits and whole grains over refined grains and avoid trans fats and added sugars. Could it be that the veggie Brits were just eating more chips? We’ll find out next.
Another strikeout trying to explain the increased risk. Could it be that the vegetarians were eating particularly unhealthy diets? Labels like vegetarian or vegan just tell me what is not being eaten. You can be vegetarian and consume a lot of unhealthy fare, like french fries, potato chips, and soda. That’s why, as a physician, I prefer the term whole food, plant-based nutrition. That tells me what you do eat. You eat vegetables and follow a diet centered around the healthiest foods out there.
If you missed the first four videos in this series, see:
Surprised about the fishy oil findings? Learn more: Is Fish Oil Just Snake Oil? and Omega-3s and the Eskimo Fish Tale.
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Michael Greger M.D. FACLM
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How do the nutrition and health effects of quinoa compare to other whole grains?
“Approximately 90% of the world’s calories are provided by less than one percent of the known 250,000 edible plant species.” The big three are wheat, corn, and rice, and our reliance on them may be unsustainable, given the ongoing climate crisis. This has spurred new interest in “underutilized crops,” like quinoa, which might do better with drought and heat.
Quinoa has only recently been introduced into the Northern Hemisphere, but humans have been eating quinoa for more than 7,000 years. Is there any truth to its “superfood” designation, or is it all just marketing hooey?
Quinoa is a “pseudograin,” since the plant it comes from isn’t a type of grass. “Botanically speaking quinoa is an achene, a seed-like fruit with a hard coat,” and it has a lot of vitamins and minerals, but so do all whole grains. It also has a lot of protein. As you can see below and in a series of graphs starting at 1:05 in my video Benefits of Quinoa for Lowering Triglycerides, quinoa has more protein than other grains, but since when do we need more protein? Fiber is what we’re sorely lacking, and its fiber content is relatively modest, compared to barley or rye. Quinoa is pretty strong on folate and vitamin E, though, and it leads the pack on magnesium, iron, and zinc. So, it is nutritious, but when I think superfood, I think of something with some sort of special clinical benefit. Broccoli is a superfood, strawberries are a superfood, and so is garlic, but quinoa? Consumer demand is up, thanks in part to “perceived health benefits,” and it has all sorts of purported benefits in lab animals, but there have been very few human studies.
The first trial was a before-and-after study of quinoa granola bars that showed drops in triglycerides and cholesterol, as you can see below and at 1:53 in my video, but it didn’t have a control group, so we don’t know how much of that would have happened without the quinoa. The kind of study I want to see is a randomized controlled trial. When researchers gave participants about a cup of cooked quinoa every day for 12 weeks, they experienced a 36 percent drop in their triglycerides. That’s comparable to what one gets with triglyceride-lowering drugs or high-dose fish oil supplements.
Which is better, regular quinoa or red quinoa? As you can see in the graph below and at 2:22 in my video, the red variety has about twice the antioxidant power, leading the investigators to conclude that red quinoa “might…contribute significantly to the management and/or prevention of degenerative diseases associated with free radical damage,” but it’s never been put to the test.
What about black quinoa? Both red and black quinoa appear to be equally antioxidant-rich, both beating out the more conventional white variety, as you can see in the graph below and at 2:46 in my video.
The only caveat I could find is to inform your doctor before your next colonoscopy or else they might mistake quinoa for parasites. As reported in a paper, a “colonoscopy revealed numerous egg-like tan-yellow ovoid objects, 2 to 3 mm in diameter, of unclear cause,” but they were just undigested quinoa.
For more on the superfoods I mentioned, check the related posts below.
Isn’t fish oil important to heart health? Find out in my video Is Fish Oil Just Snake Oil?.
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Michael Greger M.D. FACLM
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Omega-3s have long been known for their heart health benefits, but few studies have investigated their impact on those with hypertension.
Researchers of this study looked at the diets of almost 27,000 adults with hypertension to see how many omega-3 fats they were consuming from both foods and supplements.
At the end of the study, they measured both all-cause and cardiovascular mortality (any death or death specific to heart conditions).
And sure enough, eating more omega-3 fats was linked to a significantly lower risk of both all-cause and cardiovascular mortality. For heart disease in particular, the risk was estimated to be 32% to 47% lower for those who ate more omega-3s.
What’s most impressive is that this relationship was significantly beneficial when looking at the intake of just one type of omega-3 fat. (As a reminder, there are three kinds: EPA and DHA are two types of omega-3s found in fatty fish and ALA is a plant-based omega-3 found in nuts and seeds.) So people with hypertension who consumed more EPA, DHA, and ALA had a 13%, 14%, and 11% (respectively) lower risk of cardiovascular mortality.
In this study, high ALA intake was defined as 1.2 to 1.6 grams daily, whereas high levels of EPA and DHA intake were deemed to be 250 milligrams.
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Molly Knudsen, M.S., RDN
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“Like any oil (including the olive oil you cook with), rancidity can be a major issue if quality-control parameters are not top-notch,” mbg’s vice president of scientific affairs Ashley Jordan Ferira, Ph.D., RDN previously shared. And similar to cooking oils, heat, light, and oxygen (aka air exposure) are the culprits of fish oil oxidation.
Many fish oils mix anchovy, sardines, mackerel, etc. from all over1— like Chile, Peru, Turkey, Morocco, and even Norway. The act of processing these oils in addition to shipping them sometimes thousands of miles for further manufacturing (all of this occurring before the supplements even make it to your home) naturally creates space for oxidation processes to occur—especially in hot temperatures.
Sometimes manufacturers cut corners and “spike their products with cheaper, lower quality, dare I say, oxidized, types of fish oils with higher contaminant levels.” Ferira said on the mindbodygreen podcast. “Oxidation of fish oil is the crux of unpleasant fish burp.”
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Molly Knudsen, M.S., R.D.N.
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While you can certainly add a fatty fish like salmon, anchovies, tuna, or sardines to the menu a few times a week to up your EPA and DHA intake, a far simpler (and arguably, more effective and lower in heavy metals like mercury, etc.) way to reach your goal is with a targeted, high-potency omega-3 supplement.
To be honest, there’s a lot of crap on the market when it comes to fish oil supplements. Make sure you’re getting a pure, high-quality product that doesn’t skimp on its dosage of EPA plus DHA.
For example, mindbodygreen’s omega-3 potency+ delivers 1,500 (1.5 grams!) of EPA and DHA from wild-caught, cold-water anchovies that are sustainably sourced from the Pacific Ocean off the coast of Chile. Another accolade to highlight: The product is also third-party ORIVO certified for fish species and origin. Adding this premium fish oil supplement to your daily routine can increase your intake and blood levels of EPA and DHA (and benefit from the myriad health perks they offer).*
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Morgan Chamberlain
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Omega-6 fats are usually considered more pro-inflammatory, while omega-3s are considered anti-inflammatory. However, researchers argue9 that because fats are complex compounds that have different effects on the body, oils can’t be perfectly placed into “good” and “bad” boxes.
Scientists are still studying the relationship18 between omega-6 and omega-3 fats and their role in inflammation, which is highly complex and not black and white. Also, although there’s a general agreement in the nutrition world that most diets are too high in omega-6 fats, there’s no definitive consensus18 on what the optimal omega-3 to omega-6 ratio should be.
While it’s true that omega-6-rich diets may harm health by promoting an inflammatory environment in the body, the real problem isn’t omega-6 fats. According to Crouch, “While eating something with seed oils every once in a while won’t strike up an inflammatory disease process, we need to pan out and view the big picture,” she says.
The major issue with Western diets is that they tend to be high in inflammatory ultra-processed foods and deficient in omega-3 fats—and a number of other nutrients—which regulate inflammation in the body.
The omega-3s EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid)—which are readily used by the body—are concentrated in seafood9 like salmon, sardines, anchovies, and rainbow trout, as well as algae.
Omega-3s can also be found in foods like walnuts and hemp seeds, but the type of omega-3 found in these foods is poorly converted into DHA and EPA, making seafood and algae the best sources of these important fatty acids.
If you’re concerned that your intake of omega-3s is too low and your intake of omega-6 foods, like seed oils, is too high, try reducing your intake of ultra-processed foods and increasing your intake of seafood. If you don’t like fish or follow a plant-based diet, taking an algal oil supplement can help you increase your DHA and EPA intake.
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Jillian Kubala, MS, RD
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